Pilot Research Project HPV AWARENESS PREVENTS POSITIVE INFECTIONS (HAPPI): A COMMUNITY HEALTH WORKER INTERVENTION TO IMPROVE HPV AND CERVICAL CANCER SCREENING AMONG HIV POSITIVE WOMEN IN LITTLE HAITI Pilot Project Leader: Dr. Sonjia Kenya Mentor: Dr. Erin Kobetz Project Summary: Women infected with HIV, including those who are adherent to antiretroviral therapy (ART), experience an increased risk of infection with oncogenic Human Papillomavirus (HPV). the principal cause of cervical cancer(1-4) Studies in the U.S. and abroad have found that HIV positive women were at least twice as likely to have HPV.(5,6) Accordingly, it is estimated that cervical cancer risk forthis population sub-group is 68% greater than among women who are not HIV positive.(1,7) During 2000-2004, between 13 to 60% of HIV positive women in the U.S. had cervical cytological abnormalities, which can lead to invasive cervical cancer. (8) In South Florida, Black women are at greatest risk for HIV as well as developing and dying from cervical cancer. (9,10) This disparity is most prominent among Haitian Immigrant women, who represent the largest growing Black ethnic group within the Miami metropolitan area. However, to our knowledge, previous intervention efforts have not explicitly targeted this vulnerable population sub-group. Our proposed research aims to fill this gap. As part of an ongoing community-based participatory research (CBPR) initiative in Little Haiti, the predominately Haitian neighborhood in Miami, we plan to develop and implement a Community Health Worker (CHW) intervention tailored to address the unmet, unique needs of HIV positive, Haitian women. The CBPR initiative, known as Patne en Aksyon currently supports a number of studies to address the excess burden of cervical cancer among Haitian women in Little Haiti and elsewhere in the Miami metropolitan area. Consistent with the tenets of CBPR, all such efforts involve meaningful collaboration between academic and community partners. Key stakeholders from the Haitian community, active in Patne en Akyson's Community Advisory Board (CAB), typically define the scope and focus of research, as well as, the specifics of study implementation. For the proposed research, community partners both encouraged the focus on HIV positive women and selected Community Health Workers (CHWs) as the method of intervention. The intent of our proposed intervention is to improve knowledge about HPV and cervical cancer for HIV positive Haitian women. Using community-based participatory research (CBPR) methods, we will collaborate with the target population to create a culturally-sensitive HPV and cervical cancer educational curriculum, including information about accessible screening, and participating in clinical trials focused on AIDS Malignancies. The effects ofthe educational intervention on potential changes in knowledge, screening behaviors, and clinical trial participation will serve as the primary outcome measures. The intervention will be developed and implemented in two phases. For both phases, we will recruit Black women receiving care for HIV infection at one of the SUCCESS CNP community sites, the Miami Beach Community Health Center at the Center for Haitian Studies Clinic (MBCHC/CHS) located in Littie Haiti. Miami. In Phase One, we will identify HIV positive, Haitian women to participate in focus groups aimed to develop a culturally-relevant HPV/Cervical Cancer curriculum that will be used in Phase Two ofthe proposed study. Following development ofthe curriculum, we will implement a randomized controlled trial to test intervention effects (Phase Two). Forty HIV positive women that did not participate in developing the intervention curriculum will be recruited and assigned to an experimental group that receives the CHW intervention or a control group that will continue to receive standard of care (e.g., traditional clinic based education). Over six months, a CHW will conduct a series of in-person home-visits to 20 intervention participants to deliver the education curriculum. Baseline and post-study assessments will measureknowledge, screening behaviors, and clinical trial participation. Upon completion of the protocol and poststudy assessments, participants in the control condition will be offered the CHW intervention. Between group differences will be assessed at 6 months.